Ambivalence and Suicidal Behavior at Railway Stations: A Scoping Review

Suicide is a major public health concern accounting for 800 000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational–volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators (VMs), govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, VMs include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions.

The Acceptability of Suicide Among Rural Residents, Urban Residents, and College Students from Three Locations in China

At the American Association of Suicidology’s (AAS) 46th Annual Conference in Austin, Texas (http://www.suicidology.org/web/guest/education-and-training/annualconference), participants were challenged to address why there has not been more progress in reducing the rates of completed suicides (Berman, 2013). A draft of recommendations from the National Action Alliance for Suicide Prevention’s Research Prioritization Task Force was presented at the meeting and subsequently published in this journal (National Action Alliance for Suicide Prevention [NAASP], 2013a, 2013b). The purpose of this commentary is to address this challenge by emphasizing the importance of employing a disease etiology strategy that integrates molecular data with clinical data, environmental data, and health outcomes in a dynamic, iterative fashion. The recommendations of the Research Prioritization Task Force tackle important public health program issues and are embedded within seven key questions, summarized as: 1. Why do people become suicidal? 2. How do we better detect/predict risk? 3. What interventions prevent suicidal behavior? 4. What are the effective services for treating suicidal persons and preventing suicidal behavior? 5. How do we reduce stigma? 6. What are the suicide prevention interventions outside of health-care settings? 7. Which existing and new infrastructure needs are required to further reduce suicidal behavior? (NAASP, 2013b; Silverman et al., 2013)

Each year approximately 1,000,000 people die by suicide, accounting for nearly 3% of all deaths and more than half (56%) of all violent deaths in the world (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). Suicide ideation and suicide attempts are strongly linked to death by suicide and powerfully predict further suicidal behavior (Institute of Medicine, 2002). There are an estimated 100–200 suicide attempts for each completed suicide in young people, and 4 attempts for each completed suicide in the elderly (Institute of Medicine, 2002). Emergency departments (EDs) are the most important site, epidemiologically speaking, for treating those who make suicide attempts. EDs in the United States, for example, record over 500,000 suicide-related visits annually (Larkin, Smith, & Beautrais, 2008). The majority of suicide attempt patients are discharged after medical stabilization and psychosocial evaluation, but carry a significant risk of recidivism (Larkin, Smith, & Beautrais, 2008). Similarly, ED patients who present with suicide ideation (without attempt) have risks of returning to the ED with further ideation or with suicide attempts which are as high as those who present with attempts (Larkin, Beautrais, Gibb, & Laing, 2008). In addition, a significant fraction of those who present to EDs for nonmental health reasons often have occult or silent suicide ideation (estimated at 8–12%) (Claassen & Larkin, 2005). The worldwide economic tsunami and sky-rocketing healthcare costs have ensured that mental health-related visits and presentations for suicidal behavior will continue to rise in the foreseeable future. The closure of psychiatric inpatient facilities, reductions in inpatient beds, moves to treat people in the community, and increased costs of general practitioner visits have coincided with – and likely account for – increased ED attendances by psychiatric and suicidal patients who previously might have been admitted or seen in primary care. The ED is now the default, de facto option for urgent and acute contact for suicidal patients within the health system – and in many countries the ED is the only access to 24/7 healthcare (Fields et al., 2001).

Do animals commit suicide? Recently an article in the authoritative Time (Nobel, 2010) restarted the debate (Cobb, 2010), with many pros, enriched with examples and pathetic remembrances, and an indignant “no way,” including that of Rowan Hooper, editor for the News of New Scientist (Hooper, 2010). Please, do not quote lemmings or the scorpion circled by fire, stated Hooper: they do not commit suicide. Hooper is right. However, the question deserves a reply, which is slightly more complicated than a simple yes or no.

Preventing self-harm and suicide in prisoners: job half done

Prehospital Care and Transport in Acute Myocardial Infarction

A Global Call for Action to Prioritize Healthcare Worker Suicide Prevention During the COVID-19 Pandemic and Beyond.

The Impact of Patient Suicide on the Professional Reactions and Practices of Mental Health Caregivers and Social Workers

A Suicide-Specific Diagnosis – The Case Against

Can Novel Nosological Strategies Aid in the Identification of Risk for Suicidal Behavior?

Suicide deaths are tragic events and those that occur in public places have an impact not only on the deceased person and their family and friends, but also on members of the public. Having up-to-date information about the effectiveness of interventions allows policymakers and organisations managing locations of concern to choose the most appropriate evidence-based suicide prevention strategies for specific locations. This rapid review was conducted to help inform the development of Welsh national guidance.The review included literature published since 2014. 24 studies were identified, and these were conducted in the UK, Australia, South Korea, Canada, USA, Denmark and Japan. The studies covered railway or underground stations, bridges, cliffs or other natural heights, tall buildings, and other types of locations.Surveillance technologies as a means of increasing opportunity for third-party intervention showed the most promise, although the evidence of their effectiveness was limited. In one study, having more closed-circuit television (CCTV) units was associated with fewer suicides at railway stations. Another study that tested a set of interventions including CCTV, infrared security fences, and a suicidal behaviour recognition and alert system, provided some promising initial descriptive data that showed an increase in the number of prevented suicides. Three other studies showed that there was no change in outcomes following the installation of interventions including surveillance technologies. Based on the assessment of the overall body of the evidence, there is a low level of confidence in the findings related to surveillance technologies because of the quality and designs of the studies.Promotion of suicide helplines as an intervention aimed at increasing opportunities for help seeking was examined in seven studies. Two studies reported that the number of suicides increased after the introduction of the intervention. Three studies, of which two examined a set of interventions including helplines, observed no change. In two studies the effect could not be determined. There is a low level of confidence in the evidence for this outcome.Other interventions evaluated included staff training; deployment of specialist staff; campaigns encouraging bystanders to intervene; a crisis café; blue lights at railway stations; suicide prevention messages, memorials, or notes other than official crisis line signage; spinning rollers at the top of fences that prevent gripping; and others. The effect of these interventions could not be determined with certainty but some of them appeared promising and warrant further research.More robust evaluations are needed before any of the interventions reviewed here can be recommended for implementation. To create a better evidence base, high-quality evaluations should be supported and encouraged. Future research should examine which interventions work for who and in what circumstances.

Surveillance for Hepatocellular Carcinoma: Current Best Practice and Future Direction.

The study aimed to explore the suicidal process, suicidal communication and psychosocial situation of young suicide attempters in a rural community in Hanoi, Vietnam. Semi-structured interviews were conducted, in a community setting, with 19 suicide attempters aged 15-24 who had been consecutively hospitalized in an intensive care unit. In 12 of 19 cases, the first pressing, distinct and constant suicidal thoughts appeared less than one day before the suicide attempt in question. However, distress and mild, fleeting suicidal thoughts had been present up to six months before the suicide attempt in 16 cases. Five respondents had a suicide plan one to three days before attempting suicide. Altogether, 13 engaged in some form of suicidal communication before their attempt. This communication was, however, difficult for outsiders to interpret. Twelve of the respondents were victims of regular physical abuse and 16 had suffered psychological violence for at least one year before attempting suicide. Eighteen of the respondents used pesticides or raticides in their suicide attempts. None sought advice or consultation in the community despite long-standing psychosocial problems. The strategy of reducing the availability of suicide means (e.g., pesticides or raticides) in Asian countries should be complemented with a long-term suicide-preventive strategy that targets school dropouts and domestic violence, and promotes coping abilities and communication about psychological and social problems as well as recognition of signs of distress and suicidal communication.

BackgroundThere is significant interest in determining risk factors in individuals at risk of rheumatoid arthritis (RA). A core set of risk factors for clinical arthritis development has not been defined.MethodsA...